超声造影LI-RADS与增强CT/MRI LI-RADS对肝微小病灶分类的一致性及差异性研究  

Inconsistent and consistent classifications for small liver lesions by contrast-enhanced ultrasound LI-RADS and CECT/MRI LI-RADS

作　　者：梁雪[1] 潘金彬 丁建民[1] 王凤梅[3] 龙磊 周燕[1] 王彦冬[1] 经翔[1] Liang Xue;Pan Jinbin;Ding Jianmin;Wang Fengmei;Long Lei;Zhou Yan;Wang Yandong;Jing Xiang(Department of Ultrasound,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin Third Central Hospital,Tianjin 300170,China;Department of Radiology,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Gastroenterology and Hepatology,Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院超声科天津重症疾病体外生命支持重点实验室天津市人工细胞工程技术研究中心天津市肝胆研究所,300170 [2]天津医科大学总医院医学影像科,300052 [3]天津市第三中心医院消化内科,300170

出　　处：《中华超声影像学杂志》2021年第11期938-943,共6页Chinese Journal of Ultrasonography

基　　金：天津市科技计划项目(17ZXMFSY00050,17ZXMFSY00170)。

摘　　要：目的分析超声造影(CEUS)肝脏影像报告和数据系统(LI-RADS)2017版和增强CT(CECT)/MRI LI-RADS 2018版对长径≤2 cm肝微小病灶分类的一致性及差异性。方法回顾性收集2018年1月至2019年6月在天津市第三中心医院同时接受CEUS和CECT或钆塞酸二钠增强磁共振成像(EOB-MRI)检查且具有肝细胞癌(hepatocellular carcinoma,HCC)高危风险的145例患者共145个病灶,按照CEUS LI-RADS 2017版和CECT/MRI LI-RADS 2018版分类标准对病灶进行LI-RADS分类。通过Kappa检验评估两种影像学LI-RADS分类的一致性。并对CEUS和CECT/MRI LI-RADS分类不一致的病灶行进一步分析。结果145个病灶长径为(1.65±0.33)cm。CEUS及CECT/MRI分类为LR-3、4、5、M病灶数分别为16、23、90、16个和25、31、87、2个。CEUS分类为LR-5、M共106个(73.1%),CECT/MRI分类为LR-5、M共89个(61.4%),差异有统计学意义(P=0.033)。CEUS及CECT/MRI分类为LR-3、4、5类中HCC的阳性预测值分别为37.5%、52.2%、97.8%和56.0%、64.5%、96.6%。56个病灶CEUS与CECT/MRI LI-RADS分类不一致。CECT/MRI分类LR-3、4类中28个被CEUS上调为LR-4、5类,HCC所占比例为82.1%。CEUS分类LR-3、4类中14个被CECT/MRI分类上调,HCC所占比例为85.7%。结论CECT/MRI及CEUS中LR-5类对HCC均具有较高的阳性预测值,但二者对LI-RADS分类的一致性较差。CEUS分类为LR-5、M病灶数较CECT/MRI显著增多。CECT/MRI分类LR-3、4类中HCC比例高于CEUS。Objective To explore the inconsistent and consistent classifications for lesions≤2 cm by contrast-enhanced ultrasound(CEUS)Liver Imaging Reporting and Data System(LI-RADS)v2017 and contrast-enhanced computed tomography/contrast-enhanced magnetic resonance imaging(CECT/MRI)LI-RADS v2018.Methods The focal liver lesions≤2 cm underwent CEUS and CECT/MRI within 1 month were enrolled in this retrospective study.Each nodule was categorized according to the CEUS LI-RADS v2017 and CECT/MRI LI-RADS v2018.Intermodality agreement between the CEUS LI-RADS and CECT/MRI LI-RADS for each lesion was assessed with Cohen′s Kappa.Lesions with inconsistent classification for CEUS LI-RADS and CECT/MRI were analyzed.Results A total of 145 lesions with a size of(1.65±0.33)cm in 145 patients were included.The numbers of lesions in LR-3,4,5 and M were 16,23,90 and 16 on CEUS LI-RADS,25,31,87 and 2 on CECT/MRI,respectively.And 73.1%lesions were classified as LR-5 or M on CEUS,while 61.4%lesions were classified as LR-5 or M on CECT/MRI(P=0.033).The incidences of HCC in LR-3,4 and 5 were 37.5%,52.2%and 97.8%on CEUS LI-RADS,56.0%,64.5%and 96.6%on CECT/MRI LI-RADS respectively.Among the 145 lesions,56 lesions had inconsistent classifications of CEUS and CECT/MRI LI-RADS.Twenty-eight lesions in CECT/MRI LR-3 and 4 were escalated to LR-4 and 5 by CEUS and 82.1%of them were found to be HCC.Fourteen lesions on CEUS LR-3 and 4 were escalated to LR-4 and 5 by CECT/MRI and 85.7%of them were found to be HCC.Conclusions The LR-5 of the CEUS and CECT/EOB-MRI LI-RADS has a comparable incidence of HCC.However,the inter-modality agreement of the LI-RADS category between CEUS and CECT/EOB-MRI is poor.The proportion of lesions in CEUS LR-5 and M is much higher than that in CECT/MRI LR-5 and M,while the proportion of lesions in CECT/MRI LR-3 and 4 is high than that in CEUS LR-3 and 4.

关 键 词：超声造影 肝细胞癌 肝脏影像报告和数据系统 增强CT 增强MRI 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]